Low Back Pain Clinical Trial
Official title:
Precision Multi-Axis Pain Assessment of Injured Workers to Improve Treatment and Work Outcomes
NCT number | NCT06016647 |
Other study ID # | 121883 |
Secondary ID | |
Status | Recruiting |
Phase | |
First received | |
Last updated | |
Start date | August 31, 2023 |
Est. completion date | August 30, 2025 |
The percentage of loss time claims receiving Loss of Earnings benefits at 3 months has continued to rise amongst injured workers in Ontario despite the Workplace Safety and Insurance Board (WSIB) approach of "Better at Work". The primary health services to address loss time claims associated with musculoskeletal injuries include the evidenced-based programs of care, occupational health assessment program and musculoskeletal specialty programs, however, these are set to be revised and relaunched in Q1 2023. Across treatment protocols there are challenges that, at least in part, appear to contribute to the increasing percentage of workers on full loss of earnings at 3 months include (1) inconsistent early identification of workers who should be triaged to various health services and (2) reliable determination of the optimal timing of referral to the most targeted care to enable a safe and sustainable return to work. The investigators aim to develop and evaluate a predictive assessment model to triage workers to the best service within the first 8 weeks of their claim to increase the rate of early return to work, with the long-term goal that the triage protocol becomes part of a person-centric protocol that reduces the duration of work-related disability. The investigators will develop and evaluate an assessment protocol for injured workers that enter any of the musculoskeletal-specific WSIB programs of care, which have been consolidated into a single program as of 2023. This study will be a prospective inception cohort design using data collected from injured workers receiving WSIB musculoskeletal programs of care services at CBI Health clinics in Ontario Canada. Worker data will be collected at intake to the program of care service and again approximately four and eight weeks after intake (or earlier if a worker completes the program of care). The investigators will complete data analysis in three steps including descriptive and bivariate associations, Maximum Likelihood-based Latent Profile Analysis, and evaluation of results against successful work outcomes and secondary outcomes. Qualitative data will be mined for alternative indicators of recovery / non-recovery. The study recruitment goal is 300 - 350 workers with complete follow-up within a 2-year period.
Status | Recruiting |
Enrollment | 350 |
Est. completion date | August 30, 2025 |
Est. primary completion date | April 30, 2025 |
Accepts healthy volunteers | |
Gender | All |
Age group | 18 Years to 100 Years |
Eligibility | Inclusion Criteria: Eligible participants are those aged =18 years, able to read 6th grade English, presenting to a program of care for rehabilitation of a workplace injury with a primary musculoskeletal or Low Back Pain component. Exclusion Criteria: Participants with significant cognitive impairment or learning disability (self-reported) that interfere with following multi-step instructions will be excluded from this study. The exclusive focus on those entering program of care-based rehab will naturally exclude workers with catastrophic injuries (e.g., loss of limb, multiple fractures, burns) or those for whom a mental health disorder (e.g., PTSD, depression) is the primary diagnosis, thereby homogenizing the types of injuries included. |
Country | Name | City | State |
---|---|---|---|
Canada | CBI Health | Multiple Locations | Ontario |
Lead Sponsor | Collaborator |
---|---|
Dave Walton | CBI Health |
Canada,
Bennett MI, Smith BH, Torrance N, Potter J. The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain. 2005 Mar;6(3):149-58. doi: 10.1016/j.jpain.2004.11.007. — View Citation
Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap. 1994 Mar;23(2):129-38. — View Citation
Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011 Dec;20(10):1727-36. doi: 10.1007/s11136-011-9903-x. Epub 2011 Apr 9. — View Citation
Lee JY, Walton DM, Tremblay P, May C, Millard W, Elliott JM, MacDermid JC. Defining pain and interference recovery trajectories after acute non-catastrophic musculoskeletal trauma through growth mixture modeling. BMC Musculoskelet Disord. 2020 Sep 17;21(1):615. doi: 10.1186/s12891-020-03621-7. — View Citation
Modarresi S, Suh N, Walton DM, MacDermid JC. Depression affects the recovery trajectories of patients with distal radius fractures: A latent growth curve analysis. Musculoskelet Sci Pract. 2019 Oct;43:96-102. doi: 10.1016/j.msksp.2019.07.012. Epub 2019 Jul 27. — View Citation
Scheim AI, Bauer GR. The Intersectional Discrimination Index: Development and validation of measures of self-reported enacted and anticipated discrimination for intercategorical analysis. Soc Sci Med. 2019 Apr;226:225-235. doi: 10.1016/j.socscimed.2018.12.016. Epub 2019 Jan 21. — View Citation
Shi Q, Sinden K, MacDermid JC, Walton D, Grewal R. A systematic review of prognostic factors for return to work following work-related traumatic hand injury. J Hand Ther. 2014 Jan-Mar;27(1):55-62; quiz 62. doi: 10.1016/j.jht.2013.10.001. Epub 2013 Oct 21. — View Citation
Tein JY, Coxe S, Cham H. Statistical Power to Detect the Correct Number of Classes in Latent Profile Analysis. Struct Equ Modeling. 2013 Oct 1;20(4):640-657. doi: 10.1080/10705511.2013.824781. — View Citation
Walton DM, Beattie T, Putos J, MacDermid JC. A Rasch analysis of the Brief Pain Inventory Interference subscale reveals three dimensions and an age bias. J Clin Epidemiol. 2016 Jun;74:218-26. doi: 10.1016/j.jclinepi.2015.10.022. Epub 2016 Jan 6. — View Citation
Walton DM, Carroll LJ, Kasch H, Sterling M, Verhagen AP, Macdermid JC, Gross A, Santaguida PL, Carlesso L; ICON. An Overview of Systematic Reviews on Prognostic Factors in Neck Pain: Results from the International Collaboration on Neck Pain (ICON) Project. Open Orthop J. 2013 Sep 20;7:494-505. doi: 10.2174/1874325001307010494. eCollection 2013. — View Citation
Walton DM, Elliott JM, Lee J, Fakhereddin M, Seo W. Identification of clinically-useful cut scores of the Traumatic Injuries Distress Scale (TIDS) for predicting rate of recovery following musculoskeletal trauma. PLoS One. 2021 Mar 23;16(3):e0248745. doi: 10.1371/journal.pone.0248745. eCollection 2021. — View Citation
Walton DM, Elliott JM, Salim S, Al-Nasri I. A reconceptualization of the pain numeric rating scale: Anchors and clinically important differences. J Hand Ther. 2018 Apr-Jun;31(2):179-183. doi: 10.1016/j.jht.2017.12.008. Epub 2018 Feb 9. No abstract available. — View Citation
Walton DM, Elliott JM. A new clinical model for facilitating the development of pattern recognition skills in clinical pain assessment. Musculoskelet Sci Pract. 2018 Aug;36:17-24. doi: 10.1016/j.msksp.2018.03.006. Epub 2018 Apr 9. — View Citation
Walton DM, Elliott JM. An Integrated Model of Chronic Whiplash-Associated Disorder. J Orthop Sports Phys Ther. 2017 Jul;47(7):462-471. doi: 10.2519/jospt.2017.7455. Epub 2017 Jun 16. — View Citation
Walton DM, Krebs D, Moulden D, Wade P, Levesque L, Elliott J, MacDermid JC. The Traumatic Injuries Distress Scale: A New Tool That Quantifies Distress and Has Predictive Validity With Patient-Reported Outcomes. J Orthop Sports Phys Ther. 2016 Oct;46(10):920-928. doi: 10.2519/jospt.2016.6594. Epub 2016 Sep 3. — View Citation
Walton DM, Marsh J. Reliability, Discriminative, and Prognostic Validity of the Multidimensional Symptom Index in Musculoskeletal Trauma. Clin J Pain. 2020 Sep;36(9):700-706. doi: 10.1097/AJP.0000000000000856. — View Citation
Walton DM, Mehta S, Seo W, MacDermid JC. Creation and validation of the 4-item BriefPCS-chronic through methodological triangulation. Health Qual Life Outcomes. 2020 May 7;18(1):124. doi: 10.1186/s12955-020-01346-8. — View Citation
Walton DM, Phares P. The potential and perils of prognosticating persistent post-traumatic problems from a postpositivist perspective. Spine J. 2018 Aug;18(8):1483-1488. doi: 10.1016/j.spinee.2018.01.015. Epub 2018 Jan 31. — View Citation
Walton DM, Putos J, Beattie T, MacDermid JC. Confirmatory factor analysis of 2 versions of the Brief Pain Inventory in an ambulatory population indicates that sleep interference should be interpreted separately. Scand J Pain. 2016 Jul;12:110-116. doi: 10.1016/j.sjpain.2016.05.002. Epub 2016 May 25. — View Citation
Walton, D. et al. (2008) 'Prognostic Factors After Acute Whiplash Injury: Results Of A Meta-analysis', Journal of Orthopaedic & Sports Physical, 38(1), p. A23.
Wand BM, Catley MJ, Rabey MI, O'Sullivan PB, O'Connell NE, Smith AJ. Disrupted Self-Perception in People With Chronic Low Back Pain. Further Evaluation of the Fremantle Back Awareness Questionnaire. J Pain. 2016 Sep;17(9):1001-12. doi: 10.1016/j.jpain.2016.06.003. Epub 2016 Jun 18. — View Citation
* Note: There are 21 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | MultiDimensional Symptom Index (MSI) | The MultiDimensional Symptom Index (MSI), a 10-item self-report tool that uses a scoring matrix to create a profile of symptom type, frequency, and interference across 10 different symptom types. It will be primarily used to discriminate between pain of nociceptive (primarily somatic) origin (scale range 0-50) and that of more central (non-somatic) dominance (scale range 0-62). A higher score on either subscale represents a worse pain state. | 8 weeks | |
Other | A shortened 4-item version of The Self-Report version of the Leeds Assessment of Neuropathic Signs and Symptoms (S-LANSS). | A shortened 4-item version of The Self-Report version of the Leeds Assessment of Neuropathic Signs and Symptoms (S-LANSS). The S-LANSS is a 7-item scale with each item offering a simple yes/no response option. It has been well-validated against clinical diagnoses of neuropathic pain with a score =12 providing over 80% accuracy. We have previously used statistical triangulation to identify 4 of the items that combined provide a nearly perfect association with the full 7 items and offers the advantage of brevity. | 8 weeks | |
Other | The Fremantle Body Awareness questionnaire - general version (FreBAQ-general) | The Fremantle Body Awareness questionnaire - general version (FreBAQ-general). This is a 6-item questionnaire (range 0-24) derived from original version of the FreBAQ, dedicated to specific body regions (e.g., back, neck, knee, shoulder) that makes use of digital text piping to first ask the respondent about their most problematic body region, then uses that answer to populate the 6 FreBAQ-general items. A higher score indicates a greater sense of sensorimotor disconnection with painful body regions. | 8 weeks | |
Other | The Brief Pain Catastrophizing Scale (BriefPCS-4) | The Brief Pain Catastrophizing Scale (BriefPCS-4), a 4-item version of the original 13-item PCS that captures catastrophic beliefs about pain, such as 'it's awful and I feel that it overwhelms me'. The 4 items were correlated with the full 13-item version at r = 0.97 in a prior study, providing a near-perfect estimate of the full version with lower respondent burden. The scale range is 0-16 with a higher number indicating more catastrophic beliefs about pain. | 8 weeks | |
Other | The short Patient Health Questionnaire-4 item version | The short Patient Health Questionnaire-4 item version. This tool comprises two items useful as a brief screen for anxiety disorders and two as a brief screen for depressive disorders. With so few items it is far more sensitive than specific as a diagnostic tool, but as a combined score it provides a metric of negative emotional state on a 0-12 scale where a higher number represents greater emotional distress. | 8 weeks | |
Other | The Intersectional Discrimination Index - Major (InDI-M) | The Intersectional Discrimination Index - Major (InDI-M), a newer 13-item questionnaire is intended to capture experiences of discrimination/exclusion or interpersonal violence perpetrated against the respondent that is perceived to have been due to some aspect of their identity (e.g., skin colour, sex, gender, body size, age, disability, etc…). We have previously used this tool in a sample of military veterans with chronic pain and found that it shows a small but significant association with pain severity, and is a dominant driver in one sub-category of that sample with a trauma-dominant pain profile. Scale range is 0-26 with a higher score indicating more experiences of intersectional discrimination. | 8 weeks | |
Primary | Work status | Full Return-to-Work, Return-to-Work with temporary restrictions, or redirected to other treatment options. With the Full RTW category serving as the reference against which the other outcomes will be considered. | 8 weeks | |
Secondary | Pain severity | Brief Pain Inventory: These are four 0-10 rating scales that ask about pain at its best, least, on average, and right now. Reported as a mean out of 10 where a higher score indicates more intense pain. | 8 weeks | |
Secondary | EuroQoL-5D (EQ5D-5L) | EuroQoL-5D and the three additional questions. The EQ-5D has been used in its original form, and we have added 3 additional questions related to fatigue, sleep, and connections with others that patient partners have repeatedly indicated are important but are not captured in the current scale. For purposes of this analysis, and in keeping with terms of use of the EQ-5D-5L, those final 3 questions will be interpreted separately from the original items for reporting purposes. A final question on how the respondent has defined their sense of recovered/not recovered will be collected through open text to give richer information on the ways that injured workers make sense of the very notion of what it is to be 'recovered' from a workplace injury. The scale ranges from 100 ('the best imaginable health state' or 'the best health state you can imagine') to 0 ('the worst imaginable health state' or 'the worst health you can imagine'). | 8 weeks | |
Secondary | Body diagram | An interactive 'body diagram', or pain map, will be provided to allow participants to indicate the areas and extent (distribution) of their pain, which will be evaluated as a secondary prognostic indicator under the hypothesis that more widespread pain is a poor prognostic indicator for rapid recovery. Reported as a total number of shaded areas, where a higher number represents more widespread pain. | 8 weeks |
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